History of seasonal allergic rhinitis; asymptomatic this spring with preventive seasonal use of nasal corticosteroid spray.
The President has a history of activity-related injuries as noted below, which resolved without sequelae and do not impact his current duties. He continues a vigorous aerobic, weight training, and flexibility program.

Musculoskeletal low back pain secondary to heavy lifting and tight “hamstrings”; fully evaluated in 1990; asymptomatic due to current exercise and flexibility program.

Intermittent bilateral anterior knee pain, activity-related, with a left medial meniscal injury and subsequent surgical repair in 1997. Orthopedic and radiographic re-evaluation in 12/03 confirmed an old incomplete tear of the PCL of the right knee with resultant patello-femoral chondromalacia, post-traumatic degenerative changes, and asymptomatic medial meniscal damage, all most consistent with a remote athletic injury and physical activity. Symptoms resolved with quadriceps strengthening, cross-training (biking), and elimination of routine impact exercises (e.g. running) from his routine.

Right “calf” running injury (strain/tear), 4/03, most consistent with overuse. Symptoms resolved.
Minor abrasions and lacerations secondary to injuries sustained while biking, all healed without sequelae.

The President takes a daily multi-vitamin. He does not routinely use prescription medications.
Immunizations

The President’s immunizations are current for worldwide travel.
Social History

Tobacco: An occasional cigar
Alcohol: None
Caffeine: Diet sodas and coffee
Exercise: The President exercises six times per week. Workouts include bicycling (15-20 miles, 15-18mph), treadmill (low impact “hill-work”), elliptical trainer, free weight resistance training, and stretching.
Other: The President has not missed work due to illness since his last physical exam.
Physical Examination

ENT (ears, nose, throat): Nasolaryngoscopy and physical examination of the head, neck, and thyroid are normal. Thyroid function tests were normal.
Eyes: No ocular pathology was noted on ophthalmoscopic examination. Visual fields were normal. Distant visual acuity was 20/30 (r) and 20/25 (l) correctable to 20/20 in both eyes. Corrected near visual acuity was 20/20 in both eyes (the President uses reading glasses as needed).
Neurologic exam: Normal.

Pulmonary: Normal.
Gastrointestinal: Normal. Colonoscopy was last performed in June 2002. No recurrence of previously described symptoms consistent with occasional gastroesophageal reflux. Abdominal examination normal.
Cardiology: Physical examination of the circulatory system was normal. The resting EKG revealed sinus bradycardia consistent with previous exams and aerobic conditioning. Fasting lipid panel: total cholesterol No signs or symptoms of cardiovascular pathology were noted. Stress echocardiogram was normal. Screening ultrasound of the abdominal aorta was normal.

Dermatology: Lesions consistent with solar damage (e.g. telangiectasias) noted as in past. A small actinic keratosis was noted on left arm and treated with liquid nitrogen. Seborrheic keratoses also noted.
Musculoskeletal: General musculoskeletal exam was unremarkable.
Genitourinary System: Normal. PSA was 0.6 (normal < 4.0).
Laboratories

A standard battery of routine screening laboratory tests was performed and was unremarkable.

Summary

The President remains in excellent health and “fit for duty”. All data suggest that he will remain so for the duration of his Presidency. Based on an overview of his examination and history the following clinical diagnoses are made:

1. The President remains in the “superior” fitness category for men his age (greater than ninety-ninth percentile for 60-64 year-old men; Cooper).